J Korean Soc Radiol.  2011 Nov;65(5):465-472.

Differential Diagnosis of Lymphadenopathy in the Neck Spaces in a CT Perfusion Study

• Rhee SJ
• Hong HS
• Lee EH
• Park JM
• Lee MH

Abstract

PURPOSE
To evaluate the CT perfusion parameters for differentiating between a benign and malignant lymphadenopathy in the neck spaces.
MATERIALS AND METHODS
Seventeen patients with cervical lymphadenopathy underwent perfusion CT. Perfusion parameters, including blood flow (BF), blood volume (BV), permeability index (PI), and mean transit time, were calculated at the regions of interest in the enlarged lymph nodes (LNs). The enlarged LNs were diagnosed by fine needle aspiration, surgical excision, and clinical follow-up. The LNs were classified as either reactive hyperplasia (n = 26), metastatic LNs (n = 11), or LNs of lymphoma (n = 14).
RESULTS
Significant differences were found for BF, BV, and PI among the three groups (p < 0.05). Reactive hyperplasia had a significantly higher BF than metastatic LN (p < 0.0167). The LNs of lymphoma had a significantly lower BF, BV, and PI than reactive hyperplasia (p < 0.0167). No significant difference was observed between the metastatic LNs of the head and neck cancer and LNs of lymphoma for all perfusion parameters.
CONCLUSION
In patients with head and neck cancer, perfusion CT is not useful for differentiating between metastatic LNs and inflammatory reactive hyperplasia. However, perfusion CT can be useful for differentiating between LNs of lymphoma and reactive hyperplasia.

MeSH Terms

Biopsy, Fine-Needle
Blood Volume
Diagnosis, Differential
Follow-Up Studies
Head and Neck Neoplasms
Humans
Hyperplasia
Lymph Nodes
Lymphatic Diseases
Lymphoma
Neck
Perfusion
Permeability

Figure

• 

  Fig. 1 Blood flow (A), blood volume (B), permeability index (C), and mean transit time (D) of reactive hyperplasia, SCC, and lymphoma. Note.-SCC = Squamous cell carcinoma

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  Fig. 2 A 15-year-old boy with surgically proven reactive nodal hyperplasia. A. Axial contrast-enhanced computed tomography (CT) shows an enlarged lymph node at left level II (arrow) and enlargement of the tonsil (not shown). (B) BF, (C) BV, (D) PI, and (E) MTT maps show increased perfusion in the left level II lymph node (BF = 117.6 mL/100 g/min, BV = 13.3 mL/100 g, PI = 66.3 mL/100 g/min, MTT = 7.6 sec). Note.-BF = blood flow (mL/100 g/min), BV = blood volume (mL/100 g), MTT = mean transit time (sec), PI = permeability index (mL/100 g/min)

• 

  Fig. 3 A 67-year-old man with metastatic lymphadenopathy from squamous cell carcinoma from the mouth floor. A, B. Axial contrast-enhanced CT shows marginal rim enhancement of a low-density lesion in the right mouth floor (black arrows) and an enlarged lymph node at the right level II (white arrow). (C) BF, (D) BV, (E) PI, and (F) MTT maps show decreased perfusion in the right level II lymph node (white arrows) (BF = 32.8 mL/100 g/min, BV = 4.1 mL/100 g, PI = 19.8 mL/100 g/min, MTT = 8.7 sec). Note.-BF = blood flow (mL/100 g/min), BV = blood volume (mL/100 g), MTT = mean transit time (sec), PI = permeability index (mL/100 g/min)

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  Fig. 4 A 48-year-old woman with diffuse large B cell lymphoma. A. Axial contrast-enhanced CT shows multiple enlarged lymph nodes at levels I-IV (arrows). (B) BF, (C) BV, (D) PI, and (E) MTT maps show decreased perfusion in the level II lymph nodes (average BF = 55.6 mL/100 g/min, BV = 6.3 mL/100 g, PI = 23.4 mL/100 g/min, MTT = 8.8 sec). Note.-BF = blood flow (mL/100 g/min), BV = blood volume (mL/100 g), MTT = mean transit time (sec), PI = permeability index (mL/100 g/min)

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  Fig. 5 Receiver operating characteristics (ROC) curve for the perfusion parameters of benign lymph nodes and lymphoma. The areas of under the curves of blood flow, blood volume and permeability index are 0.9396, 0.8599, and 0.8187, respectively.

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